From novel idea to catalyst

In her keynote address at the 2012 mHealth Summit, which for the first time included a Global Health Track, mHealth Alliance executive director Patty Mechael said that mHealth has “transitioned from a novel idea to a strategy for global health.” She also said that 2013 would be the “year for scale,” to which I would add the ‘year of integration’, because mHealth is increasingly being applied as a game-changing approach for empowering individuals as well as strengthening health systems. There is an evolution along at least two dimensions: from initial pilots to programs with broad national or multi-regional reach, and from single-solution applications to multi-function catalysts of health system interventions.

For example, in the category of client-centered mHealth, the Mobile Alliance for Maternal Action (MAMA) provides free or low-cost text (SMS) or voice messages for pregnant women related to each stage of pregnancy and a baby’s first year. In Bangladesh, MAMA is known as Aponjon, which means “close friend.” Aponjon service was launched in September 2011 in four districts with 1,000 subscribers. It started to scale nationally in August 2012, with the aim of reaching more than two million mothers by 2015.

In “Health Workforce Capacity Development,” iHeed CEO Dr. Tom O Callaghan noted that each year, approximately 160,000 doctors are trained in Europe for a population of around 1 billion people, while in Sub-Saharan Africa for the same population size about 5,000 doctors are trained. Over the past 20 years, about 500,000 community health workers (CHWs) have been trained across Sub-Saharan Africa at a very high cost. Yet, there are 700 million mobile phones in Africa, about a billion people on Facebook, 300 million on Skype, and cheap tablets are increasingly available. “Aspirations to train another 1,000 or 10,000 CHWs seem very bland compared to the scale being achieved by other technology ventures,” O Callaghan said, suggesting that mHealth can aim much higher, training health workers and supporting their performance in innovative ways. In fact, emerging evidence indicates the potential of mHealth to positively impact multiple aspects of health systems, including adherence to treatment guidelines, supply chain management, and data collection and reporting.

Alain Labrique, founding director of the JHU Global mHealth Initiative, said that taking a health systems approach in mHealth could help bring health interventions to the “bottom billion” of the world.

There is a conundrum here. Public health research has identified interventions that save lives and improve health when instituted at the right time. But it is difficult to scale these packages of interventions broadly and with sufficient quality to be effective. Problems include health workers who don’t follow guidelines, stock-outs, lack of training and burdensome reporting systems.

mHealth is uniquely suited to address these challenges when data collection, service delivery and reporting are integrated in a system-wide solution. “These are the kinds of systems that governments are looking for,” Labrique said, “systems that integrate the thousand flowers that have bloomed in mHealth over the past five to 10 years into a bouquet of solutions that can be integrated across an enterprise.” A few examples include:

mCARE, which is being tested in northern Bangladesh, is a mobile phone health information system that integrates eight functions, including registering a pregnant woman, scheduling ANC and PNC visits, and mobilizing help for pregnancy and neonatal crises.

ChildCount+ is a free and open-source SMS platform that helps create continuity of care for children who are being tracked for nutrition status. CHWs can use any standard phone to register clients and report their health status to a central web dashboard. The platform also facilitates communication among members of the health system and provides automated alerts.

eMOCHA® is a free, open-source application in use in multiple countries globally. It provides data collection and analysis as well as training and quality management tools for frontline health workers.

Also at the Summit, FHI 360 announced the availability of tools for implementing its Mobile for Reproductive Health (m4RH) program. m4RH is a free text service that provides information about nine family planning methods as well as a clinic database. The service was piloted and evaluated in Kenya and Tanzania from 2010–2011 and began to scale nationally in each country before the end of the pilot period through partner outreach and promotional campaigns. The m4RH team is expanding message content to provide additional details related to side effects and common misconceptions and to incorporate role model stories. In addition, the service is being adapted for young people in Rwanda.